Liver Transplantation

Liver failure occurs when the liver can no longer perform its vital functions—filtering toxins, producing essential proteins, and regulating metabolism—often resulting from chronic conditions like cirrhosis or sudden insults such as drug-induced injury. While medical therapies and supportive care can stabilize many patients, those with irreversible end-stage liver disease face life-threatening complications and may be candidates for transplantation. Liver transplantation replaces the failing organ with a healthy donor liver, offering the best chance for long-term survival and restored quality of life. A thorough multidisciplinary evaluation determines each patient’s suitability, and our team supports you through every step of the transplant journey.

When It’s Needed

• End-Stage Liver Disease: Conditions like cirrhosis, hepatitis B or C, or alcoholic liver disease.
• Liver Cancer: For certain types of liver cancer that cannot be treated with other methods.
• Acute Liver Failure: Sudden liver failure caused by infections, toxins, or medications.

Types of Liver Transplants

1. Deceased Donor Transplant: The liver comes from a brain-dead donor.
2. Living Donor Transplant: A portion of a healthy liver from a living donor is transplanted. The liver regenerates in both the donor and recipient.

Benefits

• Improves quality of life and survival rates for patients with severe liver disease.
• Restores normal liver function.

What Do I Expect

During a liver transplant, here’s what you can expect:

Preparation

• Pre-Operative Evaluation: You’ll undergo comprehensive tests, including blood work, imaging studies (like CT scans or MRIs), and psychological assessments to ensure you’re a suitable candidate.
• Fasting: You’ll need to fast for several hours before the surgery like any other major surgeries.
• Medication Management: Your doctor will provide instructions on which medications to take or avoid before the procedure.

Procedure

Surgical Steps:

•   The surgeon will make an incision in your abdomen.
•  Your diseased liver will be removed, and the donor liver will be placed in its position.
• Blood vessels and bile ducts will be reconnected to ensure proper function.
• The surgery typically lasts 6–12 hours, depending on the complexity.

Post-Procedure

• Hospital Stay: You’ll stay in the hospital for 1–2 weeks for monitoring and recovery.
• Pain Management: Pain and discomfort are common but manageable with medications.
• Follow-Up Care: Regular check-ups and blood tests will be needed to monitor liver function and prevent rejection.

Safety of the Procedure

• A liver transplant is generally considered a safe and life-saving procedure, especially when performed at experienced medical centres. However, like any major surgery, it carries some risks.

Potential Risks

•  Rejection: The immune system may attack the new liver, requiring immunosuppressive medications.
• Infections: Immunosuppressants can increase the risk of infections.
• Bleeding or Clotting Issues: These are possible during or after surgery.
• Organ Failure: Rarely, the transplanted liver may not function properly.
• Long-Term Complications: High blood pressure, diabetes, or kidney problems may develop due to medications.

Benefits

• Improved Survival: Extends life expectancy for patients with end-stage liver disease.
• Enhanced Quality of Life: Restores normal liver function and alleviates symptoms like jaundice and fatigue.

After the Procedure

After a liver transplant, proper aftercare is crucial for recovery and long-term success. Here are some key aspects:

1. Medications

• You’ll need to take immunosuppressants for life to prevent organ rejection.
• Additional medications may be prescribed to manage side effects or prevent infections.

2. Follow-Up Appointments

• Regular check-ups are essential to monitor liver function and detect any signs of rejection or complications.
• Blood tests will be conducted frequently, especially in the initial months.

3. Lifestyle Adjustments

• Diet: Follow a healthy, balanced diet to support liver health. Avoid alcohol entirely.
• Exercise: Gradually resume physical activity, starting with light exercises like walking.
• Smoking: Avoid smoking, as it can hinder recovery and overall health.

4. Wound Care

•  Keep the surgical site clean and dry. Follow your doctor’s instructions for dressing changes.
• Watch for signs of infection, such as redness, swelling, or unusual discharge.

5. Monitor Symptoms

• Be alert for symptoms like fever, jaundice, or abdominal pain, which could indicate complications.

Cost of the Procedure

• Liver transplant is a hospital procedure, it is covered under most hospitalization plans.
• The procedure is also Medisave deductible. Most of the companies’ health benefits and private health insurances cover the cost of the procedure, which may extend to the private hospitals.
• The fee benchmarks on the procedure done in different hospitals can be found in the website of Ministry of Health Singapore.
• Before the endoscopic procedure, a detailed financial counselling will be done to help the patients understand the cost breakdown in the preferred hospital.
• Patients should also check with their insurance provider on the updated policy regulations before the procedure.

Our liver specialist clinic maintains close collaboration with numerous internationally recognized liver transplant centers, ensuring seamless access to world-class care. Through these partnerships, we are able to assess each patient’s unique medical needs and guide them toward the most suitable overseas transplant center, tailored to their condition and personal circumstances. This global network enhances treatment options and provides patients with greater peace of mind and timely referrals to trusted institutions Our team provides individualized assessments and seamless referrals, ensuring timely access to expert care beyond borders.

Pre-transplantation Assessment of Donor

Pre-transplantation assessment of a liver donor is a critical process to ensure the safety of the donor and the success of the transplant. Here’s an overview of the key aspects:

Medical Evaluation

1. Liver Health: Imaging tests like CT scans or MRIs assess liver anatomy, volume, and vascular structures to ensure the donor’s liver is suitable for transplantation.
2. General Health: Comprehensive blood tests, cardiac evaluations, and screenings for infections or chronic conditions are conducted to confirm the donor’s overall health.

Psychological and Social Assessment

– Donors undergo psychological evaluations to ensure they are mentally prepared for the procedure and recovery.

– Social support systems are reviewed to ensure the donor has adequate help during recovery.

Ethical Considerations

– The donor must provide informed consent, fully understanding the risks and benefits of the procedure.

– The transplant team ensures there is no coercion or undue pressure on the donor.

Pre-transplantation Assessment of Recipient

Pre-transplantation assessment of a liver transplant recipient is a comprehensive process to determine their suitability for the procedure and optimize outcomes. Here’s an overview:

Key Components of Assessment

1. Medical Evaluation:

•    Liver Disease Severity: Assessed using scores like MELD (Model for End-Stage Liver Disease) to prioritize candidates.
•    Comorbidities: Evaluation of heart, lung, and kidney function to ensure the patient can tolerate surgery.
•    Infections: Screening for active infections, including viral hepatitis and HIV.
•    Cancer Screening: Ensures no untreated malignancies outside the liver.

2. Psychosocial Assessment:

•    Mental Health: Evaluates emotional readiness and ability to adhere to post-transplant care.
•    Support System: Ensures the patient has adequate family or caregiver support during recovery.

3. Lifestyle Factors:

•    Substance Use: Patients must abstain from alcohol and drugs, with evidence of sustained sobriety if applicable.
•    Nutrition: Nutritional status is assessed and optimized pre-surgery.

4. Immunological Testing:

•    Blood typing and tissue matching to reduce the risk of organ rejection.

5. Financial and Logistical Planning:

•   Ensures the patient has access to necessary medications and follow-up care.

Post-liver Transplant Follow-up

Post-liver transplant follow-up is crucial for monitoring recovery, preventing complications, and ensuring the long-term success of the transplant. Here’s what it typically involves:

Regular Check-Ups

• Frequent visits to the transplant centre initially, which may gradually decrease as the patient stabilizes.
• Physical examinations and blood tests to monitor liver function and detect signs of rejection.

Medication Management

– Immunosuppressants: Essential to prevent organ rejection, but require careful monitoring to avoid side effects.

– Adjustments to medications based on blood test results.

Lifestyle Adjustments

• Diet: A healthy, balanced diet to support liver function and overall health.
• Exercise: Gentle activities to regain strength, avoiding strenuous exercise during the initial recovery period.
• Alcohol Abstinence: Avoiding alcohol to protect the transplanted liver.

Monitoring for Complications

• Regular screenings for infections, as immunosuppressants can weaken the immune system.
• Observation for signs of liver dysfunction or other health issues.

Liver dialysis

Liver dialysis is a specialized treatment designed to support liver function in cases of acute or acute-on-chronic liver failure. It is a treatment designed to support the liver when it is failing to perform its functions, such as detoxifying the blood, producing proteins, and regulating metabolism. It is often used as a temporary measure for patients with acute liver failure or acute-on-chronic liver failure, especially while waiting for a liver transplant or to allow the liver to recover. It works by removing toxins from the blood that the liver can no longer process. Unlike kidney dialysis, liver dialysis targets albumin-bound toxins, such as bilirubin, bile acids, and fatty acids.

Common systems include:

1. Molecular Adsorbent Recirculating System (MARS): Removes both water-soluble and albumin-bound toxins.
2. Single Pass Albumin Dialysis (SPAD): A simpler method using standard dialysis machines.
3. Prometheus System: Combines albumin dialysis with high-flux haemodialysis for enhanced detoxification.

When It’s Needed

•  Acute Liver Failure: Caused by drug overdose, infections, or toxins.
• Acute-on-Chronic Liver Failure: A sudden worsening of chronic liver disease.
• Bridge to Transplant: Helps stabilize patients awaiting liver transplantation.

Benefits

• Temporarily supports liver function.
• Reduces symptoms like jaundice and confusion caused by toxin buildup.
• Improves survival chances in critical cases.

What Do I Expect

During liver dialysis, here’s what you can expect:

Preparation

•  You may need to fast for several hours before the procedure.
• Your doctor might conduct blood tests or imaging studies to assess your condition.
• Sedation or anaesthesia may be administered to ensure comfort.

Procedure

•  A specialized machine, such as the Molecular Adsorbent Recirculating System (MARS), is used to filter toxins from your blood.
•  Blood is drawn from your body, passed through the machine to remove toxins, and then returned to your bloodstream.
• The procedure typically lasts 6–8 hours and may need to be repeated depending on your condition.

Post-Procedure

• You’ll be monitored for a short time to ensure there are no immediate complications.
• Mild fatigue or discomfort is common but temporary.
•  Your doctor will discuss the next steps, such as additional sessions or further treatment.

Safety of the Procedure

Liver dialysis is generally considered a safe and effective procedure, especially for patients with acute or acute-on-chronic liver failure. It is designed to temporarily support liver function by removing toxins from the blood, allowing the liver and other organs to recover.

Potential Risks

While liver dialysis is safe, some risks include:

• Infection: Rare, but possible at the catheter insertion site.
• Bleeding: Minor bleeding may occur, especially in patients with clotting issues.
• Allergic Reactions: Rare reactions to the materials used in the dialysis system.
• Fatigue: Some patients may feel tired after the procedure.

Benefits

•  Life-Saving: Provides critical support for patients awaiting liver transplants or recovering from liver failure. Acts as a “bridge” to liver transplantation.
• Minimally Invasive: Does not require major surgery.
•  Improved Symptoms: Reduces toxin buildup, alleviating symptoms like confusion and jaundice.
• Stabilizes patients and allows time for liver recovery.

Recent studies, such as those involving the DIALIVE device, have shown promising results, with significant improvements in symptoms and organ function.

After the procedure

After liver dialysis, proper aftercare is essential to ensure recovery and prevent complications. Here are some general guidelines:

1. Rest and Hydration: Allow your body to recover by resting adequately. Drink plenty of fluids unless your doctor advises otherwise.
2. Monitor Symptoms: Watch for signs of complications, such as fever, excessive fatigue, or unusual swelling. Report any concerns to your healthcare provider immediately.
3. Dietary Adjustments: Follow any dietary recommendations provided by your doctor to support liver health and overall recovery.
4. Medications: Take prescribed medications as directed, especially if you’re on blood thinners or other supportive treatments.
5. Follow-Up Appointments: Attend all scheduled follow-ups to monitor your liver function and overall health.

Cost of the Procedure

Liver Dialysis is usually done in the hospital, the cost of it varies depending on the hospital charges. You may be able to claim the cost depending on your insurance plan. The doctor will discuss the cost with you during the consultation.